FOUR SEASONS ResoRT CRLANDO AT WAL? OISNEY WORLG wEeS50RT CREDIT CARD AGREEMENT 10100 DREAM TREE BOULEVARD, LAKE BUENA VISTA, FLORIDA 32836 Jerrrey EpsTen! , hereby authorize the FOUR SEASONS RESORT ORLANDO at Wait Disney World® Resort to charge my credit card for the reservation as detailed below. Guest Name Confirmation Number ( e 1 ( al YS Bo33 EF S Sr Arrival Date: = 1?) L. Ta le, cI 3 | x —— _—? Departure Date: —_ a 1 ¥ P =O iX PLEASE CHECK ONE OF THE FOLLOWING: **Please note credit card will be charged in full upon receipt of this document. ** au CHARGES (Room & Tax plus $200/day for incidentals) ([] ROOM & TAX ONLY [[] OTHER i — Credit Card (ax JMC VA DS —_ Credit Card Expiration: 8, tefad| Ss — Name onCredtcrt: JEFFREY ePpSTeAl Billing Address: q EAST ms is ST City, State, Zip Code _New Yo¢ wv) OF Email Address: RK, NY jO0> Contact Number: I CERTIFY THAT THE ABOVE STATEMENT AND INFORMATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE 1 ALSO CERTIFY THAT [ AM AUTHORIZED TO EFFECT CHARGES TO THE ABOVE CRE CARD NUMBER. IN THE CASE OF ANY INQUIRIES RELATED TO THESE CHARGES ! WILL MOTIPXLOUR sania eer jae ORLANDO PRIOR TO NOTIFYING MY CREDIT CARD COMPANY. CARDHOLDER’S SIGNATURE — x € Date_ (C7 4f 20)” /\ “Please include a Government Issued motos et mate! ches the name of the cardholder. For your security, please FAX this request filled out in its entirety to the Four S. ins Ripa «t Orlando Reservations Department. The request must be received 72 hours prior to date of arrival, PheasiaS not emai this document to the Four Seasons ort Onarxdo. Internal Use: Completed _ Four Seasons Resort Orlando Apri 2017 EFTA00313946